The progressive nature of childhood asthma

The challenge of asthma in adolescence

The adolescents with asthma are a distinct group of patients with different problems and needs compared to children and adults. Specific issues of asthma in adolescence are the variability of the clinical spectrum, the presence of particular risk factors for the persistence of symptoms, underdiagnosis and undertreatment of the disease. Refusal of the sick role, denial of symptoms, carelessness about dangerous inhalation exposure, erratic self-medication, overexertion without taking precautions against exercise-induced asthma, and a poor relationship between patients, their families, and often doctors are the main obstacles to successful management of asthma in this critical age. There are also major problems of compliance for these patients. The goal of optimal quality of life will be achieved only if the physician thoroughly understands the adolescent's needs and provides optimal care.

Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus)

OBJECTIVES

The purpose of this study was to identify the factors that predict good adherence to health regimens by adolescents with diabetes (insulin-dependent diabetes mellitus).

METHODS

Altogether, 300 individuals aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Ninety-seven per cent (N=289) of the selected adolescents returned the questionnaire. The data were analysed using the SPSS (Statistical Package for Social Sciences) for Windows software package. Logistic regression was used to find the factors that predict good adherence to health regimens.

RESULTS

About one-fifth (19%) of the respondents with diabetes felt that they complied fully with the health regimens, while 75% placed themselves in the category of satisfactory adherence, and the remaining 6% reported poor adherence. The most powerful predictor was the threat to mental wellbeing. The likelihood that adolescents who felt the disease to be a threat to their mental wellbeing would comply with health regimens was 7.68-fold as compared to those who did not regard the disease as a threat to their mental wellbeing. The next most powerful predictor was support from physician. The support from nurses, and the motivation, energy and willpower to take care of themselves and the threat to physical wellbeing, also predicted good adherence. The logistic regression model explained 82% of the variance, and the model predicted correctly 88% of the adolescents with good adherence.

DISCUSSION

This paper shows that adolescents with diabetes show quite good adherence. It also indicates the factors that predict good adherence to health regimens. To improve adherence, these factors should be given special attention in the care of adolescents.

Compliance of adolescents with diabetes

The purpose of this article is to describe the compliance of adolescents with diabetes and some factors connected to it. Altogether, 300 individuals aged 13 to 17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Ninety-seven percent (N = 289) of the adolescents with diabetes returned the questionnaire. The data were analyzed by using the Statistical Package for the Social Sciences (SPSS) software. Only about one fifth (19%) of the respondents with diabetes felt that they complied fully with the health regimens, whereas 75% placed themselves in the category of satisfactory compliance and the remaining 6% reported poor compliance. Compliance with home monitoring was poorest: Only 25% said they fully complied with the home monitoring instructions, and 51% showed poor home monitoring compliance. The highest degree of compliance was reported for insulin treatment, with 81% of the patients ranking in the top category. Some statistically significant (p < .001) relationships between the degree of compliance and the background variables, such as the duration of disease; exercise; smoking; alcohol intake; and serum glycosylated hemoglobin (GHbA1c) value, were found. Good motivation, a strong sense of normality, energy and willpower, support from parents; physicians; and nurses, a positive attitude toward the disease and its treatment, no threat to one's social well-being, and fears of complications explained good compliance (p < .001).

Compliance of adolescents with asthma

The purpose of this paper is to describe the health regimen compliance of adolescents with asthma and some factors related to it. The following research questions were addressed: (i) to what extent do adolescents with asthma comply with health regimens; and (ii) what type of factors are associated with compliance of adolescents with asthma? A total of 300 individuals aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every 15th person on the list was included in the sample and were sent questionnaires. A total of 88% (n = 266) of adolescents returned the questionnaire. The results showed that 42% of the adolescents with asthma complied fully with the health regimens, 42% placed themselves in the category of satisfactory compliance, and the remaining 18% reported poor compliance. Compliance with the need to avoid foods, animals and pollens that cause asthma attacks was poorest, while the highest degree of compliance was observed for medication and control visits to medical staff. Background variables, such as age, family size, exercise, smoking, alcohol intake and severity of disease, were significantly associated with compliance (P < 0.001). Good motivation, a strong sense of normality, energy and will-power, support from the parents, physicians and nurses, a positive attitude towards the disease and treatment, no threat to social wellbeing and no fears of complications had statistically significant relation to good compliance (P < 0.001).

Secular trends in mortality from asthma in children and young adults: Republic of Ireland, 1970-91

Trends in mortality attributed to asthma in children (0-14 years) and young adults (15-44 years) and the age group 5-34 years were examined for the Republic of Ireland over the period 1970-91. Childhood mortality rates were low with no clear trend. A recent rise in asthma mortality was observed in the 5-34 year olds but not in the 15-44 year age group. More detailed examination of these rates revealed that the rise in mortality in the 5-34 year olds derived from the age band 25-34 years. This increase is masked in the 15-44 year age group by wide fluctuations in mortality in the age band 35-44 years. A similar discrepancy in asthma mortality trends for the 15-44 and 5-34 year age groups has been reported in Britain. Possible reasons for the recent rise in asthma mortality in the 25-34 year age group are discussed.

Influence of a positive family history and associated allergic diseases on the natural course of asthma

The outcome of childhood asthma was studied in a cohort of 406 asthmatic children, with emphasis on the influence of family history for allergic disease, as well as the influence of associated allergic diseases on prognosis. Sixty-two per cent had a positive family history for atopy. In young adulthood no differences, either in symptoms or lung function were demonstrated in comparison to subjects with a negative family history. Fifty-two per cent of the children had no other allergic disease, 48% had either eczema or hay fever or both. When subjects were stratified based on associated allergic disease, no differences in outcome in adulthood were revealed either. It is concluded that neither a positive family history, nor concurrent associated allergic diseases in the child contribute to the prognosis of asthma from childhood to young adulthood. Therefore, environmental factors as well as patient characteristics (including lung function level, level of bronchial responsiveness) are likely to be more important for the prognosis.